OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements

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1 OAKLAND UNIVERSITY SCHOOL OF NURSING Instructions for completing the Clinical Health Requirements Submission Deadline Dates for NEW Accelerated Second Degree and NEW Basic-BSN students Semester Admitted to Begin Nursing Courses Deadline Dates Fall (Basic-BSN) August 15th Winter (Basic-BSN) November15th Fall (ASD students) August 15th Winter (ASD students) December15th Summer (ASD students) April 15th Clinical Requirements for NEW Accelerated Second Degree (ASD) and Basic-BSN students 1. Student completes all of the clinical health requirements (refer to Clinical Requirements Submission Checklist), marks that they were completed, and signs the form. Student then enters the actual dates that the clinical health requirements were satisfied on the Student Health Requirements Satisfied form, signs the form, and attaches a copy of all clinical health requirements. The clinical health requirements that each students needs to submit are: A. Proof of inoculation for tetanus (T-DAP); skin testing for tuberculosis (possibly chest x-ray if TB skin test is positive and then student will need to also submit Health Screening Questionnaire for History of Positive TB Skin Test); and proof of immunity to Rubella, Rubeola, Mumps (MMR), Varicella, and Hepatitis B. If student elects to not take the Hepatitis B vaccines, then he/she will need to submit the Hepatitis B Vaccine Refusal and Acknowledgment of Risk and Release form. B. Submission of completed approved CPR course (AHA Healthcare Provider or Red Cross Professional Rescuer only; Heartsaver is not acceptable). Copy of card required. *If a student has a current TB test and/or CPR card, he/she can choose to use either of those documents as part of their clinical health requirements. The student will be responsible for submitting proof of updated test/card results prior to the current one s expiration date. If your updates do not arrive prior to the expiration date, your clinical attendance will be affected. C. Submission of criminal background check result (done through American Databank). D. Submission of drug screen result (done through American Databank). NOTE: The criminal background check and drug screen must be done within the 45 days prior to the submission deadline date (see table above), and they must be done through American Databank at A receipt showing the results for both the drug screen and the criminal background check is required (e.g. one page stating no flags at this time unless a record is found). The criminal background check and the drug screen are required only once; when students are admitted to begin their respective nursing curriculum. 2. Student has a health examination performed by a qualified health care provider (HCP) (e.g. physician, nurse practitioner, physician s assistant). Have the HCP complete the Clinical Experience Student Clearance Form. Health examinations may be obtained through your own HCP or at the Oakland University Graham Health Center (GHC). To schedule an appointment at the GHC, call (248) ; identify yourself as a nursing student when you make the appointment. Clinical Health Requirements Instructions updated 4/9/14

2 3. Do not submit your clinical health requirements to the School of Nursing until you have all of the documents completed. The clinical health requirements will only be accepted by the School of Nursing if submitted via trackable mail. Trackable mail (certified, registered, or priority) includes the United States Postal Service, United Parcel Service (UPS), or Fed-Ex. The clinical health requirements MUST be postmarked by no later than the submission deadline date (see above) to be considered on time. 4. Send all of the clinical health requirement documents to the School of Nursing address below: Andrea Patton Oakland University School of Nursing 3016 Human Health Building Rochester, MI Clinical Requirements for Continuing Basic-BSN Students If you were admitted to the School of Nursing in a Fall semester, your clinical health requirements will be due July 15 th every year you are a student in the School of Nursing. If you were admitted to the School of Nursing in a Winter semester, your clinical health requirements will be due October 15 th every year you are a student in the School of Nursing. 1. The student completes the necessary clinical health requirements indicated on the Student Health Requirements Satisfied form, enters the date(s) the requirements were satisfied, signs the form, and attaches a copy of the updated materials (e.g. updated TB skin test, CPR card, etc.). 2. Send all of the updated clinical health requirement documents to the School of Nursing via trackable mail (refer to #3 above) to the School of Nursing address below: Andrea Patton Oakland University School of Nursing 3016 Human Health Building Rochester, MI Lastly, it is important for students to maintain their own health insurance for illness or injury. Clinical agencies are not required to provide free treatment for students and will bill individuals for use of their emergency department or employee health service. OU does not cover any costs associated with student injuries or accidents. Any questions regarding the clinical health requirements should be directed to Andrea Patton at Please do not call the School of Nursing or contact Ms. Patton to request delivery confirmation. You can use your trackable mail receipt to find out when the clinical health requirements were delivered to OU if you so desire. Clinical Health Requirements Instructions updated 4/9/14

3 Clinical Requirements Submission Checklist Student Name (Oakland) address phone (cell or home) (circle one) G# Undergraduate track: Accelerated Second Degree or Basic-BSN (circle one) New students who do not submit all of the clinical/health requirements by the deadline date will not be allowed to start the nursing curriculum and will need to re-apply. Continuing students who do not submit all of the clinical/health requirements by the deadline date will not be allowed to register for clinical courses that semester, and their graduation date may be affected. REQUIREMENT ACCEPTABLE PROOF REQUIREMENT MET COMPLETED (Place X in the box when satisfied) CPR Course Copy of CPR card with expiration date; AHA-Health Care Provider or American Red Cross Professional Rescuer, only TB (PPD) Date and result of PPD (or negative chest x-ray and completed Health Screening Questionnaire for History of Positive TB test) (Required annually) Health Examination Health examination by qualified health care provider (must be within 4 months of admission). Have health care provider complete the Clinical Experience Student Clearance Form. Hepatitis B Hepatitis B titer indicating immunity or documented dates of 3 Hepatitis B vaccinations or signed Hepatitis B Vaccine Refusal and Acknowledgement of Risk and Release if hepatitis vaccination series not completed by deadline date. Mumps dates of 2 Mumps vaccinations. Rubella dates of 2 Rubella vaccinations. Rubeola dates of 2 Rubeola vaccinations. Tetanus (T-dap only) Documentation of T-dap injection (expires after 10 years) Varicella Drug Screen Criminal Background Check dates of 1 (one) Varicella vaccination. Follow directions provided for obtaining through American Databank Copy of results page must be included in packet. It is not necessary to include payment information Follow directions provided for obtaining through American Databank Copy of results page must be included in packet. It is not necessary to include payment information Student signature Date

4 Student Health Requirements Satisfied Form Student Name Oakland University G# Oakland address TUBERCULIN SKIN TEST (PPD) (required annually) CHEST X-RAY (If history of positive skin test) CPR requirement (Two year expiration) MM TETANUS (T-dap - within last 10 years) ATTACH LAB REPORT WITH RESULTS OF TITER OR IMMUNIZATION RECORD OF THE FOLLOWING. Positive history of disease is not acceptable documentation of immunity. MUMPS IGG TITER Immune Non-Immune RUBELLA IGG TITER Immune Non-Immune RUBEOLA IGG TITER Immune Non-Immune VARICELLA IGG TITER OR MMR Immunization Varicella Immunization Immune Non-Immune MMR # 1 MMR # 2 Varicella #1 Note: Lab report with results needed for titers HEPATITIS B VACCINE 3 required OR Hepatitis B Titer: immune non-immune Inj. #1 Inj. # 2 Inj. #3 Influenza vaccine Date received: (Given/Required October April) Student signature Date

5 Student Clinical Experience Clearance Form Student name who is a student in the Oakland University School of Nursing undergraduate program has been cleared/has not been cleared (circle one) to participate in School of Nursing clinical experiences. Health care provider signature Date Restrictions/Comments: SEN-Fall-2013

6 HEPATITIS B VACCINE REFUSAL AND ACKNOWLEDGMENT OF RISK AND RELEASE I understand that as part of my clinical experiences as a nursing student, I may be exposed to blood or other potentially infectious materials and that, as a result, I may be at risk of being infected by the Hepatitis B virus. I understand that Hepatitis B is a severe and potentially life threatening illness and that taking the Hepatitis B vaccination series would significantly reduce my risk of being infected by the Hepatitis B virus. Nevertheless, I have elected not to take the Hepatitis B vaccination series and assume responsibility for all arrangements, costs, and complications arising from not taking the Hepatitis B vaccination series. I agree to release, discharge, indemnify and hold harmless Oakland University, its trustees, officers, employees, representative and agents, and the facility where I receive my clinical training, from any and all costs, liabilities, expenses, claims, demands, or causes of action arising out of or resulting from my declining the Hepatitis B vaccination series. Student Name: Student Signature: Date:

7 Health Screening Questionnaire for History of Positive TB Skin Test The current CDC guidelines do not require biannual chest c-ray screening. It is believed that once a normal chest x-ray has been achieved, and documented, it is more important to review common signs and symptoms of pulmonary tuberculosis and assess for risk factors. Student Name: G# Date: Program: Undergraduate/Master s When did you convert to a positive PPD? When was your last chest x-ray? Result: Have you previously been treated for active or inactive TB? Yes No Date Are you experiencing any of the following: Ongoing night sweats: Yes No Unexplained weight loss: Yes No Chronic fatigue: Yes No Persistent Cough: Yes No I declare that my answers and statements are correctly recorded, complete, and true to the best of my knowledge. Signature Date This form was developed jointly by the Oakland University School of Nursing, Graham Health Center, and the Oakland County Health Department.

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